Which of the following is true regarding plating of humeral shaft fractures compared to intramedullary nailing? ipsilateral lower extremity fractures common, via artery of tarsal canal (dominant supply), deltoid branch of posterior tibial artery, may be only remaining blood supply with a displaced fracture, Subtalar, tibiotalar, and talonavicular dislocation, best view to demonstrate talar neck fractures, technique is maximum equinus, 15 degrees pronated, xray 75 degrees cephalad from horizontal, best study to determine degree of displacement, comminution and articular congruity, CT scan also will assess for ipsilateral foot injuries (up to 89% incidence), all cases require emergent closed reduction in ER, CT to confirm nondisplaced without articular stepoff, extruded talus should be replaced and treated with ORIF, ~63% of reimplanations do not require secondary procedure, low incidence of infection with adequate I&D and antibiotic therapy, visualize medial and lateral neck to assess reduction, typical areas of comminution are dorsal and medial, between tibialis anterior and posterior tibialis, preserve soft tissue attachments, especially, between tibia and fibula proximally, in line with 4th ray, elevate extensor digitorum brevis and remove debris from subtalar joint, variety of implants used including mini and small fragment screws, cannulated screws and mini fragment plates, medial and lateral lag screws may be used in simple fracture patterns, consider mini fragment plates in comminuted fractures to buttress against varus collapse, subchondral lucency best seen on mortise Xray at, indicates intact vascularity with resorption of subchondral bone, associated with talar neck comminution and open fractures, delayed internal fixation is not associated with avascular necrosis, subtalar arthritis (50%) is the most common, treatment includes medial opening wedge osteotomy of talar neck, decreased motion with locked midfoot and hindfoot, weight bearing on the lateral border of the foot, Adult Knee Trauma Radiographic Evaluation, Proximal Humerus Fracture Nonunion and Malunion, Distal Radial Ulnar Joint (DRUJ) Injuries. The likelihood of developing osteonecrosis is high, Hawkins sign is negative. (OBQ16.1) A 65-year-old female returns to the office with continued medial and lateral hindfoot pain. Web(SBQ18FA.38) A 57-year-old woman presents 2 years after undergoing bunion correction of her left foot with the inability to properly fit in her shoes in the last 4 months, despite shoe modification. Figure A is the AP radiograph of a 32-year-old right-hand dominant male who was involved in a motor vehicle accident and sustained an isolated injury. He has a temperature of 100.3 degrees Fahrenheit. Custom orthotic with Jones bar and medial posting, AFO (ankle foot orthosis) with posterior leaf spring, Accomodative plastizote insole with depression cut into the midfoot and extra-depth shoes. All of the following are considered contraindications to the use of functional bracing of a humeral shaft fracture EXCEPT: Mid-diaphyseal segmental fracture with ipsilateral pilon fracture, Mid-diaphyseal fracture with radial nerve palsy from nonballistic penetrating injury, Mid-diaphyseal closed fracture with a radial nerve palsy on presentation, Mid-diaphyseal fracture with a L1 burst fracture and paraplegia on presentation. A 65-year-old man sustained the closed injury seen in Figures A and B and is being treated nonoperatively in a functional brace. A 21-year-old male reports right ankle pain after sustaining an inversion ankle injury 2 years ago. 0% What is the next best option at this point? surgical release of tarsal tunnel. WebTibiotalar Impingement Midfoot Arthritis Neurologic Conditions occurs with forefoot fixed and hindfoot or leg rotating. (SBQ06TR.1) A 36-year-old rancher is involved in a tractor roll-over accident and sustains the injury shown in Figure A to his dominant right arm. She plays tennis and regularly walks 5 miles a day for exercise, but has had to give up these activities over the last few months because of pain. Hallux MTP dorsiflexion. Spanning external fixation of the ankle and hindfoot. On average, the radial nerve travels from the posterior compartment of the arm and enters the anterior compartment at which of the following sites? Varus malalignment after a talar neck fracture with medial comminution causes a decrease in what motion? (OBQ09.210) A 65-year-old male with insulin-dependent diabetes and chronic kidney disease presents for follow-up care for issues in his right lower extremity. Lisfranc injury. pedicle screws with internal subcutaneous bar may be used. Treatment can be nonoperative or operative depending on patient age, patient activity demands, lesion size, and stability of lesion. stabilizes ankle against plantar flexion, external rotation and pronation Anterolateral soft-tissue impingement. 12/11/2019. What is the most appropriate treatment for him at this time? No difference in rate of radial nerve injury. Tibiotalar Impingement Midfoot Arthritis lateral, and obliques. He subsequently develops talar dome avascular necrosis and is treated with the surgery shown in Figures A and B. A 65-year-old diabetic female presents with a two-month history of mild ankle pain. subchondral sclerosis and cysts. (OBQ12.74) A 43-year-old male presents with painless swelling and erythema of his ankle which resolves with elevation. However, passively correctable contractures persist and the braces are causing skin problems on the leg. A clinical photograph of the foot is provided in Figure A. (OBQ11.253) A 17-year-old ballet dancer presents with 5 months of pain in the posterior aspect of the right lower extremity that is exacerbated with the ballet position shown in Figure A. She sustains a talus fracture with associated dislocation of the subtalar joint and maintained congruence of the tibiotalar and talonavicular joints as shown in Figure A. debride impinging tissue. A 56-year-old male with uncontrolled diabetes presents for follow up of a recurrent midfoot ulceration. (OBQ05.236) A 65-year-old female developed a right foot deformity 3 years ago following a cerebrovascular accident. optional films. A 30-year-old male sustains the injury shown in figure A and undergoes successful open reduction and internal fixation. 19% (147/766) 5. On examination, he has moderate swelling and pain over the dorsum of the foot. The pain is worsened with weightbearing and walking. (OBQ11.178) A 25-year-old man presents one year after undergoing open reduction and internal fixation of the fracture seen in Figure A. Which of the following is the most likely cause of the continued pain? Removal of the implants and placement of a hindfoot arthrodesis nail or plate. (OBQ10.125) A 70-year-old woman with type 2 diabetes presents with an erythematous, swollen, and warm left foot, as depicted in Figure A. (OBQ18.141) A 48-year-old male returns to your office 8 months after sustaining a proximal humerus fracture that was successfully treated nonoperatively. (SBQ06TR.1) A 36-year-old rancher is involved in a tractor roll-over accident and sustains the injury shown in Figure A to his dominant right arm. 1% (21/2534) 3. Diagnosis is primarily made with plain radiographs of the ankle. 50% (957/1903) L 5 Osteochondral Lesions of the Talus are focal injuries to the talar dome with variable involvement of the subchondral bone and cartilage which may be caused by a traumatic event or repetitive microtrauma. She has a gastrocnemius contracture noted on Silverskiold testing. cause of impingement able to be identified in 80% of cases. He has begun to have trouble ambulating because he reports his ankle feels "floppy" since a fall several weeks ago. Webcause of impingement able to be identified in 80% of cases. Decreased risk of post-operative elbow pain. 12/11/2019. She sustained an isolated closed injury to the right arm 9 days ago. A 52-year-old male sustains a talus fracture that is treated with immediate reduction and internal fixation. Treatment is emergent reduction of the talus following by internal fixation in an acute or delayed fashion. Injection of platelet rich plasma. both the superficial and deep layers individually resist eversion of the hindfoot. (SBQ12TR.12) Anatomy. WebThe pain is worsened with weightbearing and walking. stabilizes ankle against plantar flexion, external rotation and pronation Anterolateral soft-tissue impingement. Orthobullets Team Lower rates of shoulder impingement. (OBQ12.166) Brostrum), medial malleolar osteotomy for medial and posterior lesions, longitudinal incision centered over medial malleolus, flexor retinaculum released posteriorly; PTT retracted posteriorly, osteotomy guided based of 2 parallelly placed K-wires, with goal to enter plafond at lateral extent of OLT, prior to osteotomy, 2 drill holes placed to aid in reduction following procedure, sagittal saw and osteotome used to complete osteotomy, care taken not to cause thermal necrosis to bone or damage cartilage, lateral malleolar osteotomy or ATFL/CFL release for lateral lesions, longitudinal incision centered over lateral malleolus, oblique osteotomy planned, with predrilling of small fragment screws holes to aid in reduction following procedure, alternatively, if lateral ligament reconstruction is planned, extensor retinaculum may be released, peroneal tendons retracted posteriorly and ATFL and CFL released, ankle inverted and plantarflexed to expose talar dome, OLT debrided and measured using sizing guide, appropriately sized autograft may be harvested from knee and placed into OLT, impacted gently into defect, OATs harvested from the knee have a cartilage thickness less than the native talus, this will cause immediate post-operative xrays to show a prominent graft despite the cartilage surface being flush, do not release deltoid ligament as may jeopardize deltoid artery blood supply, ankle impingement if graft plug left proud, arthroscopic harvest of chondrocytes (from ankle or alternatively from knee) are sent for cultured growth, open approach via osteotomy for implantation, debridement of lesion to create stable cartilage rim, subchondral bone exposed, bone graft may be placed if underlying cyst and bone loss, periosteum from tibia taken and fitted to defect, this is sutured into place this small caliber suture, omitting one area to leave access to underlying defect, water-tight seal confirmed, cultured chondrocytes placed under flap and suture placed, fibrin glue placed over defect, newer technique of matrix-based chondrocyte implantation (MACI) shown equivalent outcomes to ACI and may obviate need for osteotomy, small percentage of patients do not achieve pain relief regardless of treatment, Lesions may progress to involve entire ankle joint, Posterior Tibial Tendon Insufficiency (PTTI). 4% The pain is worsened with weightbearing and walking. 1% (21/2534) 3. (OBQ09.183) Increased incidence of traumatic etiology. A 60-year-old male with a history of diabetes presents to the trauma bay after sustaining a ground-level fall onto his right arm. A 25-year-old male sustained an isolated injury to his right foot after a fall from height. (OBQ05.106) often limited secondary to pain or effusion. Hallux MTP dorsiflexion. pes planus . Orthobullets Team Trauma - Elbow Dislocation; Listen Now 17:5 min. ankle inversion and dorsiflexion during axial load creates shearing of lateral talar dome and lateral OLT. WebHindfoot varus . A 34-year-old female is involved in a motorcycle crash. Which of the following statements is most accurate when comparing his treatment with open reduction and internal fixation? inspection & palpation. Lumbosacral instability. Web(OBQ11.178) A 25-year-old man presents one year after undergoing open reduction and internal fixation of the fracture seen in Figure A. Hallux MTP plantarflexion . Operative. 13% (273/2180) 4. 68% (1724/2534) 4. What is the next appropriate step in the management of this patient? (OBQ12.91) weight bearing axial and lateral films of hindfoot. She would like to proceed with a surgical intervention following a shared decision making discussion. What is the most likely deformity causing these symptoms? 6% (267/4454) optional films. A post-reduction radiograph is seen in Figure C. Which of the following is the most appropriate treatment at this time? (OBQ05.84) You can rate this topic again in 12 months. (OBQ07.173) A 34-year-old female has an insidious onset of heel pain when first getting out of bed and at the end of the day after prolonged standing. 2% (103/5321) 4. Physical exam after the injury reveals a flaccid ipsilateral limb. Operative. A 45-year-old male sustains a Gustilo and Anderson Type II open transverse humeral shaft fracture. Avascular necrosis is more common following this injury than post-traumatic arthritis, Delayed internal fixation of displaced fractures does not increase the risk of avascular necrosis, Fracture comminution is associated with a decreased avascular necrosis rate, Delayed internal fixation increased the risk of secondary surgical procedures, Fracture displacement is not associated with avascular necrosis. 33% (1730/5321) 5. (SBQ18FA.38) A 57-year-old woman presents 2 years after undergoing bunion correction of her left foot with the inability to properly fit in her shoes in the last 4 months, despite shoe modification. The likelihood of developing osteonecrosis is low. debride impinging tissue. Orthobullets Team Lower rates of shoulder impingement. Thank you. Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. Femoroacetabular impingement. The likelihood of developing osteonecrosis is low, Hawkins sign is negative. (OBQ11.178) A 25-year-old man presents one year after undergoing open reduction and internal fixation of the fracture seen in Figure A. He complains of mechanical symptoms with ankle movement that continue to be symptomatic with everyday activities. (OBQ18.209) He is currently tender to palpation on the lateral border of the foot. A 45-year-old female presents to the office wearing a right upper arm splint with radiographs shown in Figure A and B. What is the advantage of this treatment choice as compared to antegrade intramedullary nailing? Hindfoot Talar Neck FX Talus Fracture (other than neck) AIIS pins can place the lateral femoral cutaneous nerve at risk. What would be the most appropriate definitive treatment? (OBQ08.177) Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. She initially underwent early intervention with physical therapy and splinting. Cellulitis; erythema decreases after elevation, Cellulitis; abnormal Semmes-Weinstein monofilament testing, Complex regional pain syndrome (CRPS); erythema decreases after elevation, Charcot arthropathy; erythema decreases after elevation, Charcot arthropathy; erythema increases after elevation. He recalls catching his foot on astroturf with a dorsiflexion and inversion moment about his ankle. (OBQ08.115) On examination, she has severe pain and stiffness of her great toe, with crepitation. Along with irrigation and debridement, what is the most appropriate definitive management of this injury? (SBQ12TR.13) ankle inversion and dorsiflexion during axial load creates shearing of lateral talar dome and lateral OLT. However, for the last six months, he has developed persistent ankle pain with intermittent swelling. A current clinical photograph is seen in Figure A. His injury films are shown in Figures A and B. Which of the following is the strongest indication for surgical treatment of an acute humeral shaft fracture? His current imaging studies are shown in Figures E and F. Which of the following is the best next step in management? (OBQ17.175) A 22-year-old collegiate football player presents with persistent left lateral ankle pain 6 months after sustaining an ankle sprain during a game. He has an equinus contracture. Orthobullets Team Trauma - Elbow Dislocation; Listen Now 17:5 min. Elevation of the extremity reduces the hyperemia. Copyright 2022 Lineage Medical, Inc. All rights reserved. The overlying skin is intact. Figures A and B are radiographs of the left ankle. indications. anteriorinferior tibiofibular ligament impingement. contralateral foot views. Thank you. orthosis or foot wear changes to address alignment of hindfoot. His x-ray is shown in Figure A. 3% (132/4454) 5. Orthobullets Team Lower rates of shoulder impingement. Copyright 2022 Lineage Medical, Inc. All rights reserved. An orthotic with lateral hindfoot posting and first metatarsal head recess. Removal of the implants and placement of a hindfoot arthrodesis nail or plate. 50% (957/1903) L 5 Custom orthotics with first ray recession and lateral heel posting, Total contact cast and non-weight bearing, Talonavicular and tarsometarsal arthrodeses. (OBQ05.110) There is no history of trauma and he has never seen a physician before. (SBQ12TR.18) Her clinical image is depicted in Figure A and her radiograph is depicted in Figure B. What is the most likely diagnosis? He undergoes the treatment shown in Figures A and B. He presents at 2 months after surgery. Figure B shows a single entry wound located at the left distal humerus. Hip abductor weakness. He has not done any physical therapy nor received a corticosteroid injection. Radiographs are shown in Figures A-B. cause of impingement able to be identified in 80% of cases. (SBQ12FA.100) His current radiographs demonstrate a subchondral radiolucency of the dome of the talus. 19% (147/766) 5. Her clinical image is depicted in Figure A and her radiograph is depicted in Figure B. You can rate this topic again in 12 months. A 43-year-old male sustained a left ankle injury 3 years ago. pes planus . - James Stone, MD, Foot & AnkleOsteochondral Lesions of the Talus, Asymptomatic Medial Talar Dome OCD in a 17M, Osteochondral Lesions of the Talus with Midfoot Arthritis, Talus fracture, OCD, cartilage fragment, subchondral cyst. Diagnosis is made with orthogonal radiographs of the humerus. Avoidance of dancing with CAM walker boot for 2 weeks, 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Type in at least one full word to see suggestions list, Orthopaedic Summit Evolving Techniques 2021, Evolving Technique Update: Role Of An Osteotomy In The Treatment Of An Osteochondral Lesion Of The Talus - Phinit Phisitkul, MD, Orthopaedic Summit Evolving Techniques 2020, Evolving Technique Update: MSCs For Cartilage Repair: Let Me Show You How - Italy Guides The Way - Alberto Gobbi, MD, 2019 Orthopaedic Summit Evolving Techniques, Debridement And Abrasion: It's Simple And Yields Great Results: Watch Me! (OBQ16.1) A 65-year-old female returns to the office with continued medial and lateral hindfoot pain. Copyright 2022 Lineage Medical, Inc. All rights reserved. A radiograph is provided in Figure A. Figure A shows a radiograph of his left humerus. A 30-year-old professional ballet dancer presents with persistant ankle pain after an ankle sprain 6 months ago. He is treated conservatively with closed reduction and his post-reduction radiographs are shown in Figures C and D. At 6 weeks followup he presents with persistent fracture site motion. Medical comorbidities include renal insufficiency and hypertension. may be useful for surgical planning. A current radiograph is provided in Figure B. Recent midfoot and hindfoot weightbearing radiographs are seen in Figure B. Which of the following radiographic features is a good prognostic factor for this injury? He has been treating his symptoms with physical therapy and anti-inflammatory medications with little effect. Radiographs of the foot are seen in Figures A and B. A 23-year-old man presents with the injury seen in Figure A after a motor vehicle collision. 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Type in at least one full word to see suggestions list, Total Ankle Arthroplasty: Summary of Current Status, Kathryn OConnor 1University of Pennsylvania, USA See all articles by this author Search Google Scholar for this author, American Orthopaedic Foot & Ankle Society (AOFAS) Evidence-Based Medicine Committee, 30th Annual Baltimore Limb Deformity Course, Bone Ninja Demonstration: Ankle Varus - Noman A. Siddiqui, MD. However he is still having persistent anterior shoulder/arm pain that worsens with most activities. Which of the following is the most likely cause of the finding in this patient? surgical release of tarsal tunnel. The distal interlocks for this implant place which of the following nerves at risk? Posterior tarsal tunnel. inspection & palpation. (OBQ13.46) In-situ tibiotalocalcaneal fusion using an intramedullary device, Midfoot osteotomy and Lisfranc joint fusion using plates and screws, Reduction and arthrodesis of the Chopart joint using a ring fixator. (OBQ04.111) After formal debridement, which of the following is the next best treatment step? He is only able to ambulate with the assistance of crutches or a walker. the medial and lateral plantar nerves can be compressed in their own sheath distal to tarsal tunnel. What would be the most appropriate treatment for this injury? the medial and lateral plantar nerves can be compressed in their own sheath distal to tarsal tunnel. Closed reduction and splinting in the emergency room, Irrigation and debridement, then splinting in the operating room, Irrigation and debridement, then spanning external fixation in the emergency room, Open reduction and internal fixation with a compression plate in the operating room, Irrigation and debridement, then intramedullary nailing of the humerus in the operating room. After undergoing rigid anatomic fixation of the fracture, the distal radio-ulnar joint (DRUJ) remains incongruent. Physical therapy and NSAID's have not alleviated the symptoms. (OBQ11.10) He was treated with physical therapy and a controlled ankle motion boot for several weeks following the Radiographs are unremarkable. Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. Non-operative management of the humerus and plating of the femur, Plating of the humerus and intramedullary nailing of the femur, Non-operative management of the humerus and intramedullary nailing of the femur, Intramedullary nailing of the humerus and plating of the femur. motion. A 25-year-old male sustains a humeral shaft fracture and is treated with the implant seen in Figure A. Her symptoms returned with ballet activity following a 1 month course of full rest, nonsteroidal anti-inflammatory medication, and physical therapy. Hallux MTP plantarflexion . A 35-year-old male fell and sustained an open talar neck fracture. What is the most likely etiology for this observed neurologic examination? Hindfoot varus . orthosis or foot wear changes to address alignment of hindfoot. Exostectomy with placement into a protective brace, Exostectomy & achilles tendon lengthening with placement into a protective brace. lateral ankle pain due to subfibular impingement is a late symptom. Non-weight bearing bilateral lower extremities and right upper extremity, Weight bearing as tolerated bilateral lower extremities and right upper extremity, Non-weight bearing left lower extremity and weight bearing as tolerated right upper and right lower extremities, Non-weight bearing right lower extremity and weight bearing as tolerated right upper and left lower extremities, Weight bearing as tolerated bilateral lower extremities and non-weight bearing right upper extremity. (OBQ11.253) A 17-year-old ballet dancer presents with 5 months of pain in the posterior aspect of the right lower extremity that is exacerbated with the ballet position shown in Figure A. A 29-year-old male presents with left knee instability and progressive gait disturbance. Copyright 2022 Lineage Medical, Inc. All rights reserved. Ankle Arthritis is degenerative joint disease of the tibiotalar joint that can be broken into three main types: osteoarthritis, post-traumatic arthritis, and inflammatory arthritis. He has currently has no ulcerations on his foot. hindfoot valgus deformity. He recalls catching his foot on astroturf with a dorsiflexion and inversion moment about his ankle. A 29-year-old male sustains the isolated lower extremity injury shown in Figure A. may show structural changes. debride impinging tissue. After undergoing rigid anatomic fixation of the fracture, the distal radio-ulnar joint (DRUJ) remains incongruent. (OBQ06.213) 19% (147/766) 5. On examination, he has good distal pulses, weakness with attempted wrist extension, and some reported numbness of the dorsal radial hand. Total contact cast immobilization and nonweight-bearing for 6 weeks. When compared to medial talar OCDs, which of the following statements is true regarding lateral talar OCDs? He states that since he began weight-bearing he has progressive lateral foot pain and developed calluses on the lateral side of his foot that have become painful. Current radiographs demonstrate a united fracture with no evidence of ostenecrosis, subtalar or tibiotalar arthritis. What is the appropriate weightbearing status? Which of the following is the most likely long-term complication even after anatomic reduction and stable fixation is achieved? What is the most appropriate initial treatment at this time? He has an equinus contracture. posteromedial impingement lesion of ankle. He has not done any physical therapy nor received a corticosteroid injection. forward shift of more than 8 mm on a lateral radiograph is considered diagnostic for an ATFL tear. Web(OBQ17.175) A 22-year-old collegiate football player presents with persistent left lateral ankle pain 6 months after sustaining an ankle sprain during a game. All of the following are possible etiologies for this condition EXCEPT: 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Type in at least one full word to see suggestions list, 30th Annual Baltimore Limb Deformity Course, Midfoot Charcot Rocker Bottom: Hexapod Frame - Noman A. Siddiqui, MD, Failed TTC (tibio-talo-calcaneal)fusion left foot. A 30-year-old man is brought to your level 1 trauma center with a closed left diaphyseal humerus fracture, a closed left midshaft femur fracture, right sided rib fractures, and multiple facial fractures following a motorcycle accident. During open reduction, what structure must be kept intact in order to protect the remaining blood supply to the talar body? Current radiographs demonstrate a united fracture with no evidence of ostenecrosis, subtalar or tibiotalar arthritis. articular surfaces of a joint leading to subluxation or dislocation. stabilizes ankle against plantar flexion, external rotation and pronation Anterolateral soft-tissue impingement. procedure. may show structural changes. orthosis or foot wear changes to address alignment of hindfoot. Which of the following would be a contraindication to closed management with a functional brace? MRI. (OBQ11.178) Treatment can be nonoperative or operative depending on patient age, patient activity demands, severity of arthritis, and presence of tibiotalar deformity. (OBQ06.173) A 20-year-old male collegiate basketball player presents with a 1 day history of left foot pain. Examination reveals lateral elbow tenderness, and an 80 degree arc of flexion-extension and 60 degree arc of prono-supination, with extremes of motion limited by pain. Webradial head excision will exacerbate elbow/wrist instability and may result in proximal radial migration and ulnocarpal impingement. On examination, she has severe pain and stiffness of her great toe, with crepitation. What is the next most appropriate course of action? Treatment is a trial of total contact casting for acute charcot deformities without skin breakdown. Midfoot prominences associated with Charcot arthropathy, End-stage tibiotalar arthritis with limited motion. (SBQ18FA.38) A 57-year-old woman presents 2 years after undergoing bunion correction of her left foot with the inability to properly fit in her shoes in the last 4 months, despite shoe modification. 33% (1730/5321) 5. 3% (132/4454) 5. Bone Scan. He has an equinus contracture. may be useful for surgical planning. Hip abductor weakness. A decision is made to delay surgery until soft tissues are stabilized. Compared with open reduction and internal fixation with a plate and screw construct, the treatment shown in Figure A is associated with all of the following EXCEPT? He was treated with physical therapy and a controlled ankle motion boot for several weeks following the injury with minimal The fracture has healed and she now has symptomatic impingement of the dorsal surface of the talus on the distal tibia and restriction of ankle dorsiflexion. 6% (267/4454) elderly, osteopenic patients with low-energy injuries, intramedullary canal terminates 2 to 3 cm proximal to the olecranon fossa, fracture pattern: simple:A, wedge:B, complex:C, fracture location: proximal, middle or distal third, fracture pattern: spiral, transverse, comminuted, a spiral fracture of the distal one-third of the humeral shaft commonly associated with neuropraxia of the radial nerve (, will often present with shortening and in varus, preoperative or pre-reduction neurovascular exam is critical, examine and document status of radial nerve pre and post-reduction, be sure to include joint above and below the site of injury, may give better appreciation of sagittal plane deformity, rotating the patient prevents rotation of the distal fragment avoiding further nerve or soft tissue injury, may be necessary for fractures with significant shortening, proximal or distal extension but not routinely indicated, oaptation splint followed by functional brace. (OBQ12.214) Lateral calcaneus closing wedge osteotomy, Talar neck opening medial wedge osteotomy. Web(OBQ07.90) A 45-year-old diabetic male has a Wagner type 3 heel ulcer shown in Figure A that measures 4x2cm and is recalcitrant to debridements and total contact casting for 4 months. forward shift of more than 8 mm on a lateral radiograph is considered diagnostic for an ATFL tear. (OBQ09.188) To avoid impingement with the proximal ulna, you need to carefully place your fixation. However, passively correctable contractures persist and the braces are causing skin problems on the leg. test by stressing elbow with forearm in pronation to lock the lateral side. Which motor function would be expected to recover last? In addition to his lower extremity care, what other medical condition should he be evaluated for? WebHindfoot Talar Neck FX Talus Fracture (other than neck) AIIS pins can place the lateral femoral cutaneous nerve at risk. 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